Page 54 - Children Bookt.pdf

Decision-making on switching ART using viral load measurement

Children with clinical failure and/or immunological failure may not all have
virological failure, and may not need to switch to second-line therapy. However, a delay
in switching therapy in a child with high levels of viral replication may lead to greater
development of resistance and compromise the virological activity of standard second-
line regimens. It is unclear whether this translates to compromised clinical outcomes.

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or immunological failure.

Second-line regimen in the event of treament failure

YUX[ Choice of second-line regimen in the event of treatment failure
7 #!

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6
Preferred second-line
Situation
regimen regimen
INFANTS AND CHILDREN <24
MONTHS
+
&
NVP + 2 NRTIs LPV/r + 2 NRTIs

Z&
++! LPV/r + 2 NRTIs NNRTI + 2 NRTIs

K
&
NVP + 2 NRTIs LPV/r + 2 NRTIs
CHILDREN

regChildren 24 months or more NNRTI + 2 NRTIs Boosted PI + 2 NRTIs

CONCOMITANT CONDITIONS

Child or adolescent with severe
NVP + 2 NRTIs no AZT Boosted PI + 2 NRTIs
anaemia

EFV + 2 NRTIs or
Child or adolescent with TB Boosted PI + 2 NRTIs
3 NRTIs

Adolescent with hepatitis B TDF + 3TC + NNRTI Boosted PI + 2 NRTIs

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